Cumulative probability of neodymium: YAG laser posterior capsulotomy after phacoemulsification

J Cataract Refract Surg. 2003 Nov;29(11):2148-54. doi: 10.1016/s0886-3350(03)00353-5.


Purpose: To retrospectively analyze the cumulative probability of neodymium:YAG (Nd:YAG) laser posterior capsulotomy after phacoemulsification and to evaluate the risk factors.

Setting: Ando Eye Clinic, Kanagawa, Japan.

Methods: In 3997 eyes that had phacoemulsification with an intact continuous curvilinear capsulorhexis, the cumulative probability of posterior capsulotomy was computed by Kaplan-Meier survival analysis and risk factors were analyzed using the Cox proportional hazards regression model. The variables tested were sex; age; type of cataract; preoperative best corrected visual acuity (BCVA); presence of diabetes mellitus, diabetic retinopathy, or retinitis pigmentosa; type of intraocular lens (IOL); and the year the operation was performed. The IOLs were categorized as 3-piece poly(methyl methacrylate) (PMMA), 1-piece PMMA, 3-piece silicone, and acrylic foldable.

Results: The cumulative probability of capsulotomy after cataract surgery was 1.95%, 18.50%, and 32.70% at 1, 3, and 5 years, respectively. Positive risk factors included a better preoperative BCVA (P =.0005; risk ratio [RR], 1.7; 95% confidence interval [CI], 1.3-2.5) and the presence of retinitis pigmentosa (P<.0001; RR, 6.6; 95% CI, 3.7-11.6). Women had a significantly greater probability of Nd:YAG laser posterior capsulotomy (P =.016; RR, 1.4; 95% CI, 1.1-1.8). The type of IOL was significantly related to the probability of Nd:YAG laser capsulotomy, with the foldable acrylic IOL having a significantly lower probability of capsulotomy. The 1-piece PMMA IOL had a significantly higher risk than 3-piece PMMA and 3-piece silicone IOLs.

Conclusions: The probability of Nd:YAG laser capsulotomy was higher in women, in eyes with a better preoperative BCVA, and in patients with retinitis pigmentosa. The foldable acrylic IOL had a significantly lower probability of capsulotomy.

MeSH terms

  • Acrylic Resins
  • Aged
  • Aged, 80 and over
  • Capsulorhexis
  • Female
  • Humans
  • Laser Therapy*
  • Lens Capsule, Crystalline / pathology
  • Lens Capsule, Crystalline / surgery*
  • Lens Implantation, Intraocular
  • Male
  • Middle Aged
  • Phacoemulsification*
  • Polymethyl Methacrylate
  • Postoperative Complications / pathology
  • Postoperative Complications / surgery*
  • Probability
  • Retrospective Studies
  • Risk Factors
  • Sex Factors
  • Silicone Elastomers
  • Survival Analysis
  • Visual Acuity


  • Acrylic Resins
  • Silicone Elastomers
  • Polymethyl Methacrylate